title: The incidence of severe hypoglycaemia in pregnant women with type 1 diabetes mellitus can be reduced with unchanged HbA1c levels and pregnancy outcomes in a routine care setting.
abstract: OBJECTIVE
  To investigate whether the incidence of severe hypoglycaemia in pregnant women with type 1 diabetes can be reduced without deteriorating HbA1c levels or pregnancy outcomes in a routine care setting.
  
  
  METHODS
  Two cohorts (2004-2006; n=108 and 2009-2011; n=104) were compared. In between the cohorts a focused intervention including education of caregivers and patients in preventing hypoglycaemia was implemented. Women were included at median 8 (range 5-13) weeks. Severe hypoglycaemia (requiring assistance from others) was prospectively reported in structured interviews.
  
  
  RESULTS
  In the first vs. second cohort, severe hypoglycaemia during pregnancy occurred in 45% vs. 23%, p=0.0006, corresponding to incidences of 2.5 vs. 1.6 events/patient-year, p=0.04. Unconsciousness and/or convulsions occurred at 24% vs. 8% of events. Glucagon and/or glucose injections were given at 15% vs. 5% of events. At inclusion HbA1c was comparable between the cohorts while in the second cohort fewer women reported impaired hypoglycaemia awareness (56% vs. 36%, p=0.0006), insulin dose in women on multiple daily injections was lower (0.77 IU/kg (0.4-1.7) vs. 0.65 (0.2-1.4), p=0.0006) and more women were on insulin analogues (rapid-acting 44% vs. 97%, p<0.0001; long-acting 6% vs. 76%, p<0.0001) and insulin pumps (5% vs. 23%, p<0.0001). Pregnancy outcomes were similar in the two cohorts.
  
  
  CONCLUSIONS
  A 36% reduction in the incidence of severe hypoglycaemia in pregnancy with unchanged HbA1c levels and pregnancy outcomes was observed after implementation of focused intervention against severe hypoglycaemia in a routine care setting. Improved insulin treatment, increased health professional education and fewer women with impaired hypoglycaemia awareness may contribute.
authors.affiliation: Center for Pregnant Women with Diabetes, Rigshospitalet, Denmark. enel@dadlnet.dk
authors.forename: Lene
authors.initials: L
authors.lastname: Ringholm
authors.forename: A L
authors.initials: AL
authors.lastname: Secher
authors.forename: U
authors.initials: U
authors.lastname: Pedersen-Bjergaard
authors.forename: B
authors.initials: B
authors.lastname: Thorsteinsson
authors.forename: H U
authors.initials: HU
authors.lastname: Andersen
authors.forename: P
authors.initials: P
authors.lastname: Damm
authors.forename: E R
authors.initials: ER
authors.lastname: Mathiesen
mesh_terms: D001786:Blood Glucose / Q000378:metabolism; D015190:Blood Glucose Self-Monitoring; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000188:drug therapy*; D005260:Female; D005934:Glucagon / Q000627:therapeutic use; D005947:Glucose / Q000627:therapeutic use; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D007003:Hypoglycemia / Q000097:blood* / Q000188:drug therapy*; D007328:Insulin / Q000627:therapeutic use; D011247:Pregnancy; D011256:Pregnancy Outcome
chemical_list: D001786:Blood Glucose; D005934:Glucagon; D005947:Glucose; D006442:Glycated Hemoglobin; D007328:Insulin
keywords: CGM; Continuous glucose monitoring; Education; Insulin analogue; Insulin dose; Insulin pump therapy; Pregnancy; SMPG; Severe hypoglycaemia; Type 1 diabetes mellitus; continuous glucose monitoring; self-monitored plasma glucose